Page 19 - The diagnostic work-up of women with postmenopausal bleeding

the Pipelle is only 0.8%.30 However, this high sensitivity and low post-test probability 1 are based on old studies, which use D&C as reference standard. In recent years,
diagnostic hysteroscopy is considered to be the golden standard, which is more
reliable in diagnosing focal endometrial pathology.32 As a result, it is not known if
the diagnostic accuracy of endometrial sampling in women with PMB is as high as the literature claims. Maybe, focal (pre) cancers are missed in the current diagnostic work-up. To study this subject, we will perform a meta-analysis on the diagnostic performance of endometrial sampling in women with PMB, with D&C compared to hysteroscopy as a reference standard.
Outline of the thesis
This thesis is structured into nine chapters, outlined below:
• Chapter 2 presents the results of a systematic review, which provides an overview of the different diagnostic tools that are used for women with PMB.
• For clinical practice it would be useful to be able to stratify women with PMB into low versus high risk of having endometrial cancer based on patient characteristics. Chapter 3 shows the results of a systematic review of the literature on existing prediction models.The most useful model in daily practice is identified by studying results of internal validation of these models.
• To implement a prediction model in clinical practice, external validation is essential. Chapter 4 presents an external validation of a prediction model, which uses patient characteristics and ultrasound findings with a good performance in internal validation.
• In current guidelines, no consensus exists on further diagnostic work-up for and treatment of benign endometrial polyps. In chapter 5 results are presented of a randomised controlled trial (RCT) on the diagnostic work- up of women with PMB, a thickened endometrium and a benign result of endometrial sampling to reduce recurrent PMB.
General introduction
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